What are midwives perceived barriers to practicing autonomously in Australia?.

What are midwives perceived barriers to practicing autonomously in Australia?.

Literature review: What are midwives perceived barriers to practicing autonomously in Australia

Midwifery as an independent profession as described by Pairman & McAra-Couper is heavily synonymous with autonomy, relating directly to the midwife’s distinctive and unique practice, individual to that of nursing or obstetrics. This concept of autonomy denotes that midwives work within their scope of practice, and are both responsible and accountable for their professional judgments. While autonomy is recognized as a key feature in contemporary midwifery practice, research has identified obstacles regarding its full attainment. This paper aims to explore the literature relating to the concept of autonomous midwifery practice and answer the question, on what midwives perceive as barriers to professional autonomy and realizing one’s full scope of practice within Australia.

Midwifery refers to obstetrics or the techniques and practice of a midwife. A midwife is a recognized professional who is responsible for and who works with women to give necessary support and care during pregnancy, labor and the postnatal period. He or she conducts birth and care for the newborn and infant. In Australia, midwifery is regarded as a sub-specialty of nursing and due to this, their services are mostly not autonomous especially with the dominance of the high prevalence of obstetricians that practice privately. Over the years, there have been concerns among midwives in Australia that their right to performing autonomously within the full scope of their profession is hindered by the existing medical dominance. They have listed a number of issues they regard as barriers to their autonomy and have moved to seek independence.

Autonomy is the ability of one to act independently, often making rational decisions without the influence of others. Professionally, it refers to the right granted by most government bodies to members of a professional class to work without supervision. This also means that there is limited external influence when it comes to undertaking their professional duties (Beauchamp, 2001). In essence, what the midwives in this country want is recognition of their professionalism and therefore the need to be granted professional autonomy.

Research among the midwives in Australia reveals that the above-mentioned medical dominance is one of the barriers that limit or hinder professional autonomy (Brodie, 2002). The medical dominance is in reference to the specific influence of nursing on midwifery and the need for midwives to operate within the hospital setting. This is one of the strongest points made by authors in various literatures on the subject and the main complaint from respondents in various researches. Midwifery adopts a more holistic approach in its operation while the modern medical practice on the same relies heavily on technological advancements (Homer et al, 2009). Majority of midwifery practice in Australia is conducted within the modern hospital setting. It is therefore little wonder that the profession of midwifery is slowly slipping into oblivion.

A qualitative study by Callaghan revealed that two care models namely the medical model and the midwifery model are in competition, with the philosophies and cultures of the former overshadowing those of the latter (Callaghan, 1996). This means that more women are embracing the medical model over that of midwifery, and midwives are forced to work within the same model and thus sacrificing their autonomy in a bid to wave off opposition. It is obvious that they are struggling to remain relevant in the field of obstetrics and any measure taken to safeguard this is welcomed by the majority. While this study may be termed as outdated, the study conducted in later years by Brodie on five hundred and sixty three Australian midwives found that medical dominance and its subsequent philosophies has resulted in a perceived reduction, in autonomy and a narrowing of skill set and sphere of practice. This is especially so because of the expressed need of midwives to work independently using their professional model. Historically, midwives were seen as radical and their ability to acquire Medicare rebates for their clientele hindered through government lobbying. It is only recently that maternity care reforms reflected in the National Health Insurance Act have allowed midwives to obtain the said rebates. This is however limited by a condition dictating that an obstetrician must oblige and thereafter provide written evidence that they are willing to collaborate with a particular midwife during the primary care.

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